1295871317 NPI number — DR. PAUL DANA HARBOTTLE D.D.S.

Table of content: DR. PAUL DANA HARBOTTLE D.D.S. (NPI 1295871317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295871317 NPI number — DR. PAUL DANA HARBOTTLE D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARBOTTLE
Provider First Name:
PAUL
Provider Middle Name:
DANA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295871317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
681 TITICUS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH SALEM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10560-1801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-669-9626
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 ROUTE 202
Provider Second Line Business Practice Location Address:
SOMERS PROFESSIONAL COMMONS
Provider Business Practice Location Address City Name:
SOMERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10589-3222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-277-3518
Provider Business Practice Location Address Fax Number:
914-277-1020
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  045872 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 009121 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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